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Lee J, Chung M, Sung ES, Yoon JP, Yoo YM, Bae J, Kim HY. Use of oxygen reserve index during bronchoscopic balloon dilation for subglottic stenosis in a patient with left ventricular assist device implantation -a case report. Korean J Anesthesiol 2024; 77:273-277. [PMID: 37814398 PMCID: PMC10982534 DOI: 10.4097/kja.23568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Monitoring the oxygenation status is crucial during general anesthesia to ensure patient safety. Although noninvasive pulse oximetry is commonly used to monitor percutaneous oxygen saturation (SpO2), it may not accurately reflect changes in oxygen partial pressure when the latter is excessively high or low. The oxygen reserve index (ORi) provides real-time information about the oxygen reserve status. CASE We present a case of successful management of subglottic stenosis using balloon bronchoscopy in an infant with a left ventricular assist device implantation under ORi monitoring to predict hypoxemia during the surgical procedure. CONCLUSIONS Utilizing ORi monitoring during anesthesia for procedures involving apnea in critically ill infants can help predict impending desaturation before a drop in SpO2 occurs, allowing anesthesiologists to effectively anticipate and manage the apnea period. Continuous ORi monitoring offers valuable insights during surgical procedures, especially in infants with compromised respiratory and cardiovascular functions.
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Affiliation(s)
- Jimin Lee
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Minwoo Chung
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Eui-Suk Sung
- Department of Otolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
| | - Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Yeong Min Yoo
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Jaesang Bae
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hee Young Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
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Hu L, He N, He S, Jiao Y. Endoscopic balloon dilatation in the management of paediatric- acquired subglottic stenosis in children. Auris Nasus Larynx 2024; 51:161-166. [PMID: 37544811 DOI: 10.1016/j.anl.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To summarise our experience and the outcomes of endoscopic balloon dilatation (EBD) in the management of paediatric-acquired subglottic stenosis (SGS), and to further explore the influencing factors of successful EBD. METHOD A retrospective case series study was conducted involving 33 paediatric patients diagnosed with acquired SGS who underwent EBD as the primary treatment from January 2012 to December 2021. The collected information included patient demographics, aetiology, time from extubation to operation, initial grade of SGS, descriptions of stenosis tissues, presence of tracheotomy, number of dilatation procedures and co-morbidity. The follow-up results were collected and analysed. RESULT Thirty-three paediatric patients with an average age of 31.0 months who underwent EBD were included in the study. According to the Myers-Cotton classification, four (12.1%) patients had Grade I stenosis, nine (27.3%) had Grade II, 20 (60.6%) had Grade III and none had Grade IV. Of these, 15 (45.5%) exhibited acute lesions and 18 (54.5%) exhibited chronic lesions. The mean number of dilatation procedures per patient was 1.88 ± 1.05, and 19 (57.6%) patients received dilatations more than once. The overall success rate was 72.7%, with 100% for Grade I, 88.9% for Grade II and 60.0% for Grade III. There was a significant difference between the distribution of the stenosis grades in the successful and failed cases (p < 0.05). The mean number of dilatation procedures was 1.47 ± 0.64 and 2.22 ± 1.22 per patient in those with acute lesions and chronic lesions, respectively. The patients with chronic lesions had a significantly higher number of dilatations than those with acute lesions (p < 0.05). The success rate was 86.7% for acute lesions and 61.1% for chronic lesions. The correlation between the type of subglottic lesions and procedural success was not statistically significant (p > 0.05). CONCLUSION Acquired SGS in paediatric patients can be successfully managed using EBD. The dilatation procedures should be performed in a timely manner, early treatment could prevent the need for multiple procedures and smaller stenosis grades could improve the success rate of the surgery.
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Affiliation(s)
- Lanye Hu
- Department of Otolaryngology and Oral and Maxillofacial Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ning He
- Department of Otolaryngology Head and Neck Surgery, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shan He
- Department of Otolaryngology and Oral and Maxillofacial Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Jiao
- Department of Otolaryngology and Oral and Maxillofacial Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Alshammari J, Halawani M, Arafat A, Alkhaldi A, Masud N. Efficacy of Cricotracheal Stenosis Resection (CTSR) Among Children with Congenital vs. Acquired Sub-glottic Stenosis. Indian J Otolaryngol Head Neck Surg 2023; 75:1755-1761. [PMID: 37636724 PMCID: PMC10447872 DOI: 10.1007/s12070-023-03731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
Sub-glottic Stenosis (SGS) treatment in children is challenging because there is no standard algorithm to follow; however, the use of endoscopic techniques in SGS treatment has emerged over the last decades and has advanced. The aim of this study was to assess the efficacy of Cricotracheal Stenosis Resection (CTSR) among children with congenital vs. acquired SGS. In this retrospective study, we reviewed the charts of 22 patients who underwent endoscopic intervention as the primary modality of treatment for SGS at King Abdulaziz Medical City from January 1, 2011 to October 31, 2019. Successful treatment was defined as: resolution of symptoms, restoration of a normal patent airway with no stenosis, and decannulation. Out of 22 patients, 14 cases were acquired and 8 were congenital SGS. Most of the patients had grade 3 stenosis before surgery 15 (68%), followed by grade 1 stenosis among 4 (18.2%) and grade 2 stenosis was present in 3 (13.6%) patients. Postoperatively, 17 (77.3%) patients improved to grade zero, whereas grade 3 stenosis was not reported in any patient. The Mc-Nemar's test showed significant improvement between pre- and post-operative stenosis grade with test value = 22, and P value = 0.003. This technique was successful among 18 (82%) patients with P value ≤ 0.01. Irrespective of the differences in the age of patients, length, and character of stenosis among congenital and acquired groups, the endoscopic CTSR technique proved to be successful in both groups. We achieved a success rate of 86% in the acquired series, and 75% in the congenital series, which is a very promising result.
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Affiliation(s)
- Jaber Alshammari
- Division of Otolaryngology Head & Neck Surgery, King Abdulaziz Medical City (KAMC), King Abdullah Specialized Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh (KAIMRC), Riyadh, Saudi Arabia
| | - Mohammed Halawani
- Division of Otolaryngology Head & Neck Surgery, King Abdulaziz Medical City (KAMC), King Abdullah Specialized Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh (KAIMRC), Riyadh, Saudi Arabia
| | - Abdullah Arafat
- Division of Otolaryngology Head & Neck Surgery, King Abdulaziz Medical City (KAMC), King Abdullah Specialized Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh (KAIMRC), Riyadh, Saudi Arabia
| | - Abdullah Alkhaldi
- Division of Otolaryngology Head & Neck Surgery, King Abdulaziz Medical City (KAMC), King Abdullah Specialized Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center Riyadh (KAIMRC), Riyadh, Saudi Arabia
| | - Nazish Masud
- King Abdullah International Medical Research Center Riyadh (KAIMRC), Riyadh, Saudi Arabia
- Research unit, College of medicine, King Saud bin Abdulaziz University for Health Sciences Riyadh, Riyadh, Saudi Arabia
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张 光, 王 崇, 彭 帅, 谷 瑞, 谢 晓, 罗 健, 罗 征. [The Effect of Interventional Treatment with Bronchoscopy in 10 Children with Acquired Subglottic Stenosis]. Sichuan Da Xue Xue Bao Yi Xue Ban 2022; 53:166-170. [PMID: 35048619 PMCID: PMC10408871 DOI: 10.12182/20220160109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the effects of interventional therapy with bronchoscopy in children with acquired subglottic stenosis (SGS). METHODS The clinical data of ten pediatric inpatients with acquired SGS who were admitted to Children's Hospital of Chongqing Medical University, as well as their follow-up information obtained 1 week, 1 month, 3 months and 6 months after the procedure was done.were retrospectively analyzed to examine the effect of interventional bronchoscopic therapies, including balloon dilatation, holmium laser, and cryotherapy, in pediatric patients with acquired SGS. RESULTS Among the 10 patients with acquired SGS, there were 5 boys and 5 girls aged between 1 month and 6 years and 5 months, with a median age of 11 months and 1 day. Among the 5 patients with acute acquired SGS, two were treated with balloon dilatation only, with one cured and one showing clinical improvement, while three received comprehensive interventional therapy combining balloon dilatation, holmium laser, and cryotherapy, with two cured and one showing improvement. Among the 5 patients with chronic acquired SGS, four cases were cured with comprehensive interventional therapy, while one case suffered from aggravated upper airway obstruction 4 + hours after balloon dilatation. The patient was subsequently put on invasive mechanical ventilation for 4 days, but was unable to be extubated. The parents signed do-not-resuscitate order and the patient died afterwards. Bronchoscopy performed 1 week, 1 month and 3 months after the procedure was done showed that the SGS was improved to varying degrees. CONCLUSION Bronchoscopy intervention is an effective therapy for acquired SGS in children.
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Affiliation(s)
- 光莉 张
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 崇杰 王
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 帅 彭
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 瑞雪 谷
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 晓虹 谢
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 健 罗
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 征秀 罗
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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Furuta S, Nagae H, Ohyama K, Tanaka K, Kitagawa H. Therapeutic effectiveness of costal cartilage grafting into both anterior and posterior walls for laryngotracheal reconstruction in acquired subglottic stenosis. Pediatr Surg Int 2021; 37:555-559. [PMID: 33486563 DOI: 10.1007/s00383-020-04812-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND We have reviewed the surgical procedures performed and outcomes for low-birth-weight infants with acquired subglottic stenosis. METHODS The gestational age at birth, birth weight, age at Laryngotracheal reconstruction, and therapeutic outcome over the past 26 years were reviewed. Laryngotracheal reconstruction was initially performed by costochondral grafting involving only the anterior wall for the first operation, but since 2010 a costal cartilage was also inserted into the posterior wall of the cricoid cartilage using the BENSON pylorus spreader to split the cartilage. RESULTS There were 21 patients. The mean gestational age was 29.6 weeks, the mean birth weight was 1127 g, and the first surgery was performed at a mean age of 37.0 ± 21.8 months. Extubation was possible in 11 of 21 patients (52.3%) after the first surgery and in 7 of 7 patients after re-operation. The total extubation rate reached 100% (18/18) excluding three patients (one who suffered sudden death, and two who were lost to follow-up). CONCLUSION Sufficient dilatation of the subglottic space could not be achieved by costochondral grafting involving the anterior wall alone. The extubation rate was improved by dilatation of the posterior wall and the insertion of costal cartilage into both the anterior and posterior walls.
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Affiliation(s)
- Shigeyuki Furuta
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 241-8511, Japan
| | - Hideki Nagae
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 241-8511, Japan
| | - Kei Ohyama
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 241-8511, Japan
| | - Kunihide Tanaka
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 241-8511, Japan
| | - Hiroaki Kitagawa
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 241-8511, Japan.
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Schweiger C, Eneas LV, Manica D, Netto CSS, Carvalho PRA, Piva JP, Kuhl G, Marostica PJC. Accuracy of stridor-based diagnosis of post-intubation subglottic stenosis in pediatric patients. J Pediatr (Rio J) 2020; 96:39-45. [PMID: 30243644 DOI: 10.1016/j.jped.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the accuracy of stridor in comparison to endoscopic examination for diagnosis of pediatric post-intubation subglottic stenosis. METHOD Children who required endotracheal intubation for >24h were included in this prospective cohort study. Children were monitored daily and underwent flexible fiberoptic laryngoscopy after extubation. Those with moderate-to-severe abnormalities underwent another examination 7-10 days later. If lesions persisted or symptoms developed, laryngoscopy under general anesthesia was performed. Patients were assessed daily for stridor after extubation. RESULTS A total of 187 children were included. The incidence of post-extubation stridor was 44.38%. Stridor had a sensitivity of 77.78% (95% confidence interval [95% CI]: 51.9-92.6) and specificity of 59.18% (95% CI: 51.3-66.6) in detecting subglottic stenosis. The positive predictive value was 16.87% (95% CI: 9.8-27.1), and the negative predictive value was 96.15% (95% CI: 89.9-98.8). Stridor persisting longer than 72h or starting more than 72h post-extubation had a sensitivity of 66.67% (95% CI: 41.2-85.6), specificity of 89.1% (95% CI: 83.1-93.2), positive predictive value of 40.0% (95% CI: 23.2-59.3), and negative predictive value of 96.07% (95% CI: 91.3-98.4). The area under the receiver operating characteristic (ROC) curve was 0.78 (95% CI: 0.65-0.91). CONCLUSIONS Absence of stridor was appropriate to rule out post-intubation subglottic stenosis. The specificity of this criterion improved when stridor persisted longer than 72h or started more than 72h post-extubation. Thus, endoscopy under general anesthesia can be used to confirm subglottic stenosis only in patients who develop or persist with stridor for more than 72h following extubation.
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Arianpour K, Forman SN, Karabon P, Thottam PJ. Pediatric acquired subglottic stenosis: Associated costs and comorbidities of 7,981 hospitalizations. Int J Pediatr Otorhinolaryngol 2019; 117:51-56. [PMID: 30579088 DOI: 10.1016/j.ijporl.2018.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/10/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Numerous risk factors have been characterized for acquired subglottic stenosis (ASGS) in the pediatric population. This analysis explores the comorbidities of hospitalized ASGS patients in the United States and associated costs and length of stay (LOS). METHODS A retrospective analysis of the Kids' Inpatient Database (KID) from 2009 to 2012 for inpatients ≤ 20 years of age who were diagnosed with ASGS. International Classification of Diseases, Clinical Modification, Version 9 diagnosis codes were used to extract diagnoses of interest from 14, 045, 425 weighted discharges across 4179 hospitals in the United States. An algorithm was created to identify the most common co-diagnoses and subsequently evaluated for total charges and LOS. RESULTS ASGS was found in 7981 (0.06%) of total discharges. The mean LOS in discharges with ASGS is 13.11 days while the mean total charge in discharges with ASGS is $114,625; these values are significantly greater in discharges with ASGS than discharges without ASGS. Patients with ASGS have greater odds of being co-diagnosed with gastroesophageal reflux, Trisomy 21, other upper airway anomalies and asthma, while they have lower odds of being diagnosed with prematurity and dehydration. Aside from Trisomy 21 and asthma, hospitalizations of ASGS patients with the aforementioned comorbidities incurred a greater LOS and mean total charge. CONCLUSION Our analysis identifies numerous comorbidities in children with ASGS that are associated with increased resource utilization amongst US hospitalizations. The practicing otolaryngologist should continue to advocate interdisciplinary care and be aware of the need for future controlled studies that investigate the management of such comorbidities.
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Affiliation(s)
| | - Suzanne N Forman
- Department of Pediatric Otolaryngology, Beaumont Children's Hospital, Royal Oak, MI, USA; Department of Otolaryngology, Michigan State University, East Lansing, MI, USA
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Prasad John Thottam
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA; Department of Pediatric Otolaryngology, Beaumont Children's Hospital, Royal Oak, MI, USA; Department of Otolaryngology, Michigan State University, East Lansing, MI, USA; Department of Otolaryngology, Wayne State University, Detroit, MI, USA; Michigan Pediatric Ear, Nose and Throat Associates, West Bloomed, MI, USA.
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Abstract
The subglottis is a narrow region of the pediatric airway that is exquisitely susceptible to the development of airway stenosis. The incidence of acquired subglottic stenosis in the setting of prolonged intubation has significantly decreased because of improved endotracheal tube management protocols. Advances in otolaryngology interventions, such as balloon dilation and endoscopic cricoid split techniques, may allow the avoidance of tracheostomy in patients with mild to moderate subglottic stenosis. However, patients with severe subglottic stenosis are often tracheostomy dependent. Open surgical techniques to treat severe disease, such as laryngotracheal reconstruction and cricotracheal resection, offer high rates of tracheostomy decannulation.
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Affiliation(s)
- Alexander P Marston
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, MUSC Children's Hospital, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - David R White
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, MUSC Children's Hospital, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
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Sekioka A, Fukumoto K, Yamoto M, Takahashi T, Nakaya K, Nomura A, Yamada Y, Urushihara N. Serial intralesional triamcinolone acetonide injections for acquired subglottic stenosis in premature infants. Pediatr Surg Int 2018; 34:1047-1052. [PMID: 30062559 DOI: 10.1007/s00383-018-4312-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Long-term intubation of premature infants sometimes induces acquired subglottic stenosis (SGS), causing glottic or supraglottic problems. These kinds of SGS often require tracheostomy and subsequently make decannulation difficult. The aim of our study was to clarify the efficacy of repeated intralesional steroid injections to the stenosis. METHODS Six children with acquired SGS, who were treated with triamcinolone acetonide injections to the subglottic space just below the vocal folds between September 2015 and December 2017 were retrospectively reviewed. RESULTS The patients' mean age was 4.3 (range 1.3-4.4) years, the mean gestational age at birth was 25 (23-28) weeks, and the mean birth weight was 591 (456-734) g. The degree of SGS was grade II in one patient and III in five patients, with both tracheostoma and glottic or supraglottic abnormalities. They generally underwent ten procedures, every 3-4 weeks. In most cases, the patency of the injected space improved by 25-220%, and the symptoms were relieved. One patient achieved decannulation, and another one underwent laryngotracheal reconstruction and decannulation. Two patients started using a speech cannula. There were no severe complications. CONCLUSION Serial intralesional steroid injections are likely to be effective in improving the patency of acquired SGS.
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Affiliation(s)
- Akinori Sekioka
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan.
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Toshiaki Takahashi
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Kengo Nakaya
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Akiyoshi Nomura
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Yutaka Yamada
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka Prefecture, 420-8660, Japan
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Vilanova A, De la Torre CA, Sánchez-Galán A, Hernández Oliveros F, Encinas JL, Ortiz R, Núñez Cerezo V, De la Serna O, Barrio MI, Castro L, Builes L, Verdú C, López Santamaría M. [Long-term results of the early endoscopic treatment of acquired tracheal-subglottic stenosis: 10 years of experience]. Cir Pediatr 2018; 31:8-14. [PMID: 29419952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Acquired stenosis of the airway is a common complication after endotracheal intubation. Endoscopic dilation has been accepted as the treatment of choice in cases detected precociously. Our goal is to know the current status of the patients treated in our hospital with endoscopic dilation in the last 10 years. MATERIAL AND METHODS Retrospective cohort study of patients with subglottic and tracheal acquired stenosis (STAS) early treated endoscopically with balloon dilation at our center in the last 10 years. Bronchoscopy control at 2 weeks, a month, 3 and 6 months post-dilation were performed and later on depending on the symptoms. RESULTS 32 patient were treated in the period considered. The median age was 4.5 (3-120) months. There were necessary 2.5 (1-5) dilations per patient. All cases were extubated in the operating room or in the following 24 hours. There were no complications during the procedure. Follow-up time was 6 (1-10) years. Only 1 of the 32 patients have had recurrence of stenosis 2 years after, it was secondary to reintubations due to new surgical interventions; which it was dilated successfully. CONCLUSIONS Early endoscopic dilation in the acquired airway stenosis is a safe and effective long-term procedure. The results support the use of this technique as a treatment of choice in these patients.
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Affiliation(s)
- A Vilanova
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - C A De la Torre
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - A Sánchez-Galán
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | - J L Encinas
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - R Ortiz
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - V Núñez Cerezo
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - O De la Serna
- Servicio de Neumología Pediátrica. Hospital Universitario La Paz. Madrid
| | - M I Barrio
- Servicio de Neumología Pediátrica. Hospital Universitario La Paz. Madrid
| | - L Castro
- Servicio de Anestesia y Reanimación Pediátrica. Hospital Universitario La Paz. Madrid
| | - L Builes
- Servicio de Anestesia y Reanimación Pediátrica. Hospital Universitario La Paz. Madrid
| | - C Verdú
- Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario La Paz. Madrid
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Alshammari J, Alkhunaizi AA, Arafat AS. Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review. Int J Pediatr Adolesc Med 2017; 4:33-37. [PMID: 30805497 PMCID: PMC6372454 DOI: 10.1016/j.ijpam.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/10/2016] [Accepted: 11/22/2016] [Indexed: 11/27/2022]
Abstract
Background and objectives To share our experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and critically review the previously published studies. Setting Tertiary Referral Centers, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients and methods A retrospective case series study was conducted, where the case notes of all pediatric patients who underwent endoscopic management as a primary surgical intervention for acquired subglottic stenosis (SGS) from 2004 to 2014 were reviewed. All patients who underwent surgical correction with primary open laryngoplasty for congenital subglottic stenosis had been excluded. Results A total of 60 patients with a workable diagnosis of subglottic stenosis were reviewed. Forty-five patients were included in the study and 15 patients were excluded because they underwent open laryngoplasty as a primary treatment modality for congenital subglottic stenosis. The majority of the patients were males 29 (64%), with 16 (36%) females. The main presentation was stridor and intercostal recession. Thirty-nine (86%) patients had subglottic stenosis due to prolonged intubation; 5 (11%) patients were idiopathic and one patient (3%) had inflammatory reasons. The site of stenosis was isolated SGS in 41 while 4 patients had glottic-subglottic stenosis (GSGS). In terms of the grade of stenosis: 13 patients had grade I; 23 had grade II and 9 had grade III. The character of stenosis was soft except in 5 patients with hard (mature) scar. The number of dilatation procedures ranged from 1 to 6 with a mean of 2. The endoscopic management was considered to be successful when the patient is completely asymptomatic after the follow up period of one year. No major complications were recorded among the patients. Thirty-seven (82.3%) patients had a benign course post endoscopic intervention without complications and 8 (17.7%) underwent a secondary open surgical management due to re-stenosis (P value < 0.01). Conclusion Our study showed that primary endoscopic management was successful in 82.3% of cases of acquired subglottic stenosis including those with high grade stenosis and long segment of more than 12 mm in terms of the craniocaudal length. CO2 laser was an important tool to convert mature hard stenotic segment into a soft one. The latter yielded to the lateral pressure created by balloon dilatation better.
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Affiliation(s)
- Jaber Alshammari
- King Saud bin Abdulaziz University for Health Sciences (KASU-HS) - Riyadh, Saudi Arabia, King Abdulaziz Medical City (KAMC) - Riyadh, Saudi Arabia, P.O.Box 22490, Riyadh 11426, Saudi Arabia
| | - Arwa A Alkhunaizi
- King Abdulaziz Medical City (KAMC) - Riyadh, Saudi Arabia, P.O.Box 22490, Riyadh 11426, Saudi Arabia
| | - Abdullah S Arafat
- King Saud bin Abdulaziz University for Health Sciences (KASU-HS) - Riyadh, Saudi Arabia, P.O.Box 3660, Riyadh 11481, Saudi Arabia
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12
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Abstract
Subglottic stenosis (SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower border of the cricoid cartilage. With the introduction of prolonged intubation in neonates (mid 1960s), acquired SGS became the most frequent cause of laryngeal stenosis; unlike congenital SGS, it does not improve with time. Laryngeal reconstruction surgery evolved as a consequence of the need to manage these otherwise healthy but tracheotomized children. Ongoing innovations in neonatal care have gradually led to the salvage of premature and medically fragile infants in whom laryngeal pathology is often more severe, and in whom stenosis often involves not only the subglottis, but also the supraglottis or glottis-causing significant morbidity and mortality. The primary objective of intervention in these children is decannulation or preventing the need for tracheotomy. The aim of this article is to present a more detailed description of both congenital and acquired SGS, highlighting the essentials of diagnostic assessment and familiarizing the reader with contemporary management approaches.
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Affiliation(s)
- Niall D Jefferson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-30309
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-30309
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229-30309; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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13
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Morita K, Yokoi A, Bitoh Y, Fukuzawa H, Okata Y, Iwade T, Endo K, Takemoto J, Tamaki A, Maeda K. Severe acquired subglottic stenosis in children: analysis of clinical features and surgical outcomes based on the range of stenosis. Pediatr Surg Int 2015; 31:943-7. [PMID: 26272075 DOI: 10.1007/s00383-015-3773-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study analyzed the clinical features and surgical outcomes of laryngotracheal reconstruction (LTR) in pediatric patients with severe acquired subglottic stenosis (SGS) based on the range of stenosis. The aim was to clarify the indications for LTR in severe acquired SGS. METHODS The medical records of 33 pediatric patients with severe acquired SGS (Myer-Cotton grade III or IV) at our institution between January 1994 and December 2013 were retrospectively reviewed. RESULTS Nine patients had stenosis localized at the subglottis (localized SGS), and twenty-four patients had stenosis extending to the glottis or supraglottis from the subglottis (extended SGS). 66.7 % (6/9) of localized SGS patients were intubated after infancy, and 95.8 % (22/23) of extended SGS patients were intubated in the neonatal period. The duration of intubation was significantly shorter with localized than with extended SGS. Sixteen patients underwent LTR. The operation-specific decannulation rate was 80.0 % (4/5) in the localized SGS group and 14.3 % (1/7) in the extended SGS group. CONCLUSION The range of stenosis was affected by the period and duration of endotracheal intubation. Surgical outcomes of LTR tended to differ between localized SGS and extended SGS. LTR can be effective for localized SGS.
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Affiliation(s)
- Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
| | - Yuko Bitoh
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
| | - Yuichi Okata
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
| | - Tamaki Iwade
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
| | - Kosuke Endo
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
| | - Junkichi Takemoto
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
| | - Akihiko Tamaki
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan
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Ahn HJ, Kim JA, Yang M, Lee EK. Respiratory insufficiency and dynamic hyperinflation after rigid bronchoscopy in a patient with relapsing polychondritis -a case report-. Korean J Anesthesiol 2013; 65:569-73. [PMID: 24427466 PMCID: PMC3888853 DOI: 10.4097/kjae.2013.65.6.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/10/2012] [Accepted: 10/23/2013] [Indexed: 11/10/2022] Open
Abstract
Relapsing polychondritis (RP) is an uncommon disease that is characterized by inflammation and destruction of cartilaginous structures. When tracheobronchial tree is involved, respiratory obstructive symptoms can occur. A 35-year-old man, with a previous diagnosis of RP, was scheduled for rigid bronchoscopy to relieve dyspnea, caused by subglottic stenosis. After laser splitting of the subglottic web, the spontaneous respiration of the patient was insufficient, and hypercarbia developed progressively even with assisted ventilation. After 20 minutes of aggressive hyperventilation to reduce end-tidal CO2 level, sudden extreme tachycardia and hypotension developed. Ventilation rate was reduced and prolonged expiration time was allowed to alleviate a near-tampon status from dynamic hyperinflation. After the hemodynamic status was stabilized, the patient was transferred to the ICU for mechanical ventilation. He received ICU care for 30 days, and now, he was on supportive care on a ward, considering Y stent insertion to prevent luminal collapse from tracheobronchomalacia.
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Affiliation(s)
- Hyun-Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyung Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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